MEDICARE: JORDAN EDWARD GRANT WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor	11938592-6004	UT

General Provider Information

NPI Number	:	1760005193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN EDWARD GRANT WRIGHT

Provider Business Mailing Address
First Line	:	145 E 900 S STE 6
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-4241
Country	:	US
Telephone Number	:	423-315-7903
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 E 900 S STE 6
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-4241
Country	:	US
Telephone Number	:	423-315-7903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	08/09/2023

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Directions to “ JORDAN EDWARD GRANT WRIGHT ” Practice Location

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